by Dr Agilan Arjunan , Fertility Specialist & Gynaecologist, KL Fertility Centre ( Malaysia)
Main take home point of this article :
As a fertility doctor, I suggest a young couple who needs an IVF to discuss about IVF protocol without or with very minimal injections. In my practice , I see a good success rate if the couples are selected properly.
IVF is associated with daily injections of hormones. These hormones are needed to stimulate grow of multiple follicles ( eggs) and to create more than one embryo per IVF cycle.
This approach is commonplace because cumulative pregnancy rate is higher when up to 10-14 eggs are collected per IVF cycle. While a standard IVF protocol may be good to achieve a higher pregnancy rate, it also has its own disadvantages.
A standard IVF protocol carries a risk of ovarian hyperstimulation (OHSS) , longer days off work , especially after egg collection procedure and a higher total IVF cost .
Probably it’s time to look at a more gentle , perhaps an IVF without or with very minimal injections.
A recent analysis from Japan have looked into the success rate of an IVF protocol with Clomifene Citrate. For a young couple ( female partner less than 34 yrs old) , the cumulative pregnancy rate after three IVF cycles is about 70% .
In an IVF protocol with oral tablets, the women makes only a few eggs per stimulation . Hence, she may need to repeat the IVF cycle to make more embryos. In a younger couple, generally few eggs are enough to make a good quality embryo. Furthermore , it is much more patient friendly.
On the aspect of cost, the cost of an IVF cycle can reduce significantly and thus a couple be able to do more than one stimulation cycle .
In my practice, I normally suggest a minimal stimulation IVF for a young couple, provided they fulfil the selection criteria. I see a very good success rate with this approach while reducing the overall IVF cost.
In conclusion, younger couples who need an IVF should discuss about minimal stimulation IVF with their doctor.